Hip spica cast and undergarment for use with hip spica cast

ABSTRACT

An undergarment for use with a cast tape to form a hip spica cast, such as a pantaloon-type hip spica cast. The cast includes at least one layer of a 3D spacer synthetic padding material formed into a fabric of monofilament yarns and fabricated into an anatomically correct undergarment structure for being positioned around a torso and residing directly against the skin of a hip spica cast patient.

TECHNICAL FIELD AND BACKGROUND OF THE INVENTION

This invention relates to an undergarment formed of orthopedic padding,for example, for use as an undercast padding of the type used to protectand cushion the skin of a patient from the relatively rigid material ofa cast, such as those constructed of plaster of Paris or synthetic casttape. Specifically, this invention relates to a hip spica cast intendedprimarily for infants and other pediatric patients. The cast isconstructed of an undercast padding material characterized by having avery open water and air transmissive structure enclosed within a veryopen water and air transmissive cast tape.

A cast which includes the torso of the body and one or more limbs iscalled a spica cast. A hip spica includes the torso of the body and oneor more legs. A hip spica which covers only one leg to the ankle or footmay be referred to as a single hip spica, while one which covers bothlegs is called a double hip spica. A one-and-a-half hip spica encasesone leg to the ankle or foot and the other to just above the knee. Theextent to which the hip spica covers the torso depends greatly on theinjury and the surgeon; the spica may extend only to the navel, allowingmobility of the spine and the possibility of walking with the aid ofcrutches, or may extend to the rib cage or even to the armpits in somerare cases. Hip spicas are used for a number of conditions and injuries,such as congenital hip dislocation or dysplasia.

In some cases, a hip spica may only extend down one or more legs toabove the knee. Such casts, called pantaloon casts, are used toimmobilize an injured lumbar spine or pelvis, in which case the torsoportion of the cast usually extends to or just below the armpits. Thespecific example discussed in this application is such a pantaloon cast,but the invention is not limited to this particular type of cast.

A traditional hip spica cast is constructed from a simple stockinetteand padding material made from cotton or synthetic fibers, and offerspoor or no water resistant capability. Cotton and some synthetic paddingactually absorb and retain large quantities of water. A hip spica castis typically worn for a period of 6-10 weeks. During this period oftime, traditional casts having a water-absorbent stockinette can promoteskin maceration and discomfort. This is a particular problem withinfants and very small children who are incontinent and therefore arefar more likely to soil the cast with urine and feces. To facilitatetoileting or diaper changing and hygienic cleaning, an opening, referredto as the “perineal opening”, is typically created in the cast at thegroin. It is formed either during cast application or after castapplication by cutting the hole with a cast saw. The opening must thenbe petalled or lined to keep this area of the cast clean and dry.However, this is difficult, particularly with infants and smallchildren. In reality, within a relatively short period of time aftertraditional hip spica cast application, the area around the perinealopening becomes soiled with urine and feces and develops foul odors thatmust be tolerated or masked with various deodorizers for a month ormore. Rashes, maceration, skin and systemic infections, open sores andother conditions may retard the treatment schedule and impose pain anddiscomfort on the infant or pediatric patient.

The present invention provides a more conformable, water-resistantproduct that permits the material to be formed into ananatomically-shaped and sized undergarment that can be donned onto thepatient, and then enclosed by wrapping with a suitable water and airpermeable synthetic cast tape to form the spica cast.

One of the problems with conventional cast padding as well ascommercially available water resistant padding is that the paddingcollapses underneath a cast over the duration of 4-6 weeks as water andperspiration are absorbed into the structure. This reduction inthickness and resultant increase in density retards moisture transfer byboth wicking and evaporation, and lessens the protection offered by thepadding.

The hip spica cast according to the present invention accommodatesbathing, showering and contact with water for cleansing while permittingsurface moisture to be dried, and moisture on the interior of the hipspica cast to evaporate relatively quickly, leaving the patient dry andcomfortable. For smaller patients, the patient can be held in proximityto, for example, a handheld spray nozzle and the cast sprayed with agentle spray of warm, cleansing water. Urine is readily washed away, andfeces are dissolved, diluted and allowed to drain away. The patient isleft clean and odor-free. Excess surface water is easily blotted awaywith an absorbent cloth or paper towel, and water on the interiorevaporates within about one hour. This process can be repeated asnecessary during the entire treatment period. Moreover, because of theability to cleanse the patient as described above, it may not benecessary to provide the perineal opening in some instances.

SUMMARY OF THE INVENTION

Therefore, it is an object of the invention to provide a hip spica castformed from a water and air permeable padding material formed into agarment, and enclosed within a water and air permeable synthetic casttape. It is another object of the invention to provide an orthopedicpadding that is comfortable when worn under a synthetic cast.

It is another object of the invention to provide a hip spica cast in theform of a garment that is relatively thin but still providing sufficientcushioning and thus provides a low profile undercast layer when properlyoverlapped during application.

It is another object of the invention to provide a hip spica cast thatis relatively open and therefore breathable.

It is another object of the invention to provide a hip spica cast thatis resistant to collapse during extended use.

It is another object of the invention to provide a hip spica cast thatpromotes drainage of water from the cast when wetting occurs.

It is another object of the invention to provide a breathable hip spicacast that is comfortable when worn against the skin under a wrapping ofsynthetic cast tape.

These and other objects of the present invention are achieved byproviding an undergarment for use with a cast tape to form a hip spicacast, and comprising at least one layer of a 3D spacer synthetic paddingmaterial formed into a fabric of monofilament yarns and fabricated intoan anatomically correct undergarment structure for being positionedaround a torso and residing directly against the skin of a hip spicacast patient.

According to another embodiment of the invention, the undergarment has atorso portion and at least one integrally-formed leg portion.

According to another embodiment of the invention, the undergarment has atorso portion including a top opening for being positioned on a torsoportion of the patient and at least one integrally-formed leg portionterminating in a leg opening adapted to reside between the hip and kneeof the patient.

According to another embodiment of the invention, the undergarment has atorso portion including a top opening for being positioned on a torsoportion of the patient and at first and second leg portions terminatingin respective leg openings adapted to reside between the hips and kneesof the patient.

According to another embodiment of the invention, the undergarment has atorso portion including a top opening for being positioned on a torsoportion of the patient and at first and second leg portions terminatingin respective leg openings adapted to reside between the hips and kneesof the patient, and wherein the undergarment is formed of first andsecond overlaid padding layers defining an anterior side of theundergarment and third and fourth overlaid padding layers defining aposterior side of the undergarment.

According to another embodiment of the invention, the first and secondpadding layers and the third and fourth padding layers are joined alongleft and right seam lines extending from a top opening to first andsecond leg openings at a lowermost terminus of the undergarment.

According to another embodiment of the invention, the monofilament yarnsare thermoplastic and the seam lines are formed by ultrasonic energy orother suitable methods, such as by butt or overedge seaming, or with anadhesive, either in tape or atomized glue form.

According to another embodiment of the invention, the undergarmentincludes a perineal opening.

According to another embodiment of the invention, the undergarment isconfigured to form an undergarment for a pantaloon hip spica cast.

According to another embodiment of the invention, the cast tape isselected from the group consisting of a synthetic fiber orfiberglass/non-fiberglass substrate coated or saturated with amoisture-curable resin and stored in a flexible condition in a moistureimpervious package until use, at which time removal of the cast tapefrom the moisture impervious package and exposure to moisture causes thesubstrate to harden over a time period sufficiently long enough to allowapplication of the cast tape while still flexible over the undergarment.

According to another embodiment of the invention, an undergarment foruse with cast tape to form a hip spica cast is provided, and includes atleast one layer of a 3D spacer synthetic padding material formed into aknitted fabric of monofilament yarns and fabricated into an anatomicallyappropriate undergarment structure for being positioned around a torsoand residing directly against the skin of a hip spica cast patient, thefabric for the padding material formed with at least 50 courses permeter preferably 200-850 courses per meter, and the padding materialweighs between 50-400 g/m² and has a nominal thickness when notcompressed or under tension of approximately 1.5-3.5 mm.

According to another embodiment of the invention, the undergarment has atorso portion including a top opening for being positioned on a torsoportion of the patient and at first and second leg portions terminatingin respective leg openings adapted to reside between the hips and kneesof the patient, and wherein the undergarment is formed of first andsecond overlaid padding layers defining an anterior side of theundergarment and third and fourth overlaid padding layers defining aposterior side of the undergarment.

According to another embodiment of the invention, the first and secondpadding layers and the third and fourth padding layers are joined alongleft and right seam lines extending from a top opening to first andsecond leg openings at a lowermost terminus of the undergarment.

According to another embodiment of the invention, a hip spica cast isprovided and includes, an undergarment comprising at least one layer ofa 3D spacer synthetic padding material formed into a fabric ofmonofilament yarns and fabricated into an anatomically correctundergarment structure for being positioned around a torso and residingdirectly against the skin of a hip spica cast patient, and a cast tapehaving a synthetic fiber or fiberglass/non fiberglass substrate coatedor saturated with a moisture-curable resin and stored in a flexiblecondition in a moisture impervious package until use, at which timeremoval of the cast tape from the moisture impervious package andexposure to moisture causes the substrate to harden over a time periodsufficiently long enough to allow application of the cast tape whilestill flexible over the undergarment. The cast tape is positionedcircumferentially over the undergarment and around the torso of thepatient.

BRIEF DESCRIPTION OF THE DRAWINGS

Some of the objects of the invention have been set forth above. Otherobjects and advantages of the invention will appear as the inventionproceeds when taken in conjunction with the following drawings, inwhich:

FIG. 1 is a perspective view of a hip spica cast undergarment accordingto one embodiment of the invention;

FIG. 2 is a perspective view of an alternative hip spica castundergarment according to another embodiment of the invention, providedwith a perineal opening;

FIG. 3 is an exploded view showing formation of the undergarment of FIG.1 or 2 by overlaying multiple sheets of padding material;

FIG. 4 is an environmental view showing a padding undergarment in placeon an infant; and

FIG. 5 is a view showing the hip spica cast after cast tape has beenapplied over the undergarment padding material.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENT OF THE INVENTION AND BESTMODE

Referring now specifically to the drawings, a hip spica undergarment 10is shown. The particular hip spica undergarment 10 is a pantaloon hipspica that extends from below the armpits of the patient to above theknees. As noted above, there are other types of hip spica casts, andthose are included within the scope of the invention even though notfurther described. The undergarment 10 includes a torso 12 and twointegrally-formed legs 14 and 16 that are constructed of front and backblanks 18 and 20 of padding material. The patient is positioned in theundergarment 10 through a waist opening 22 with its legs extendingthrough respective leg openings 24, 26. The undergarment 10 shown isseamed up the left and right sides and up the inside of each leg 14, 16by ultrasonic welding of the synthetic material from which the blanks 18and 20 are formed. One suitable material from which the undergarment 10is constructed is a padding in sheet form that is presently sold instrips as Delta-Dry® brand synthetic padding manufactured and sold byBSN medical, Inc. and BSN medical, GmbH. FIG. 2 illustrates a hip spicapantaloon undergarment 30, which includes a torso 32 and twointegrally-formed legs 34 and 36 that are constructed of front and backsheets of Delta-Dry® brand synthetic padding material 38 and 40. Thepatient is positioned in the undergarment 30 through a top opening 42with its legs extending through respective leg openings 44, 46, Theundergarment 30 shown is seamed up the left and right sides and up theinside of each leg 34, 36 by ultrasonic welding of the syntheticmaterial from which the blanks 38 and 40 are formed. The seam may alsobe formed by any suitable method, such as by butt or overedge seaming,or with an adhesive, either in tape or atomized glue form. Undergarment30 includes a perineal opening 50, which may be preformed in theundergarment 30 when constructed, or may be cut out to a desired size,position and shape during application.

As shown in FIG. 3 with reference to the undergarment 10 shown in FIG.1, each blank 18 and 20 are themselves preferably formed of two layersof padding material 18A, 18B, and 20A, 20B, such as Delta-Dry® brandsynthetic padding. The double thickness provided by the layers 18A, 18Band 20A, 20B provide comfort and aids in protecting the skin fromcontact with the chemicals present on the cast tape applied over theundergarment 10. A double layer provides enhance comfort while stillproviding a moisture vapor transmission rate (MVTR) of over 1000 g/m²/24hrs. Other embodiments may include single thickness or three or morethicknesses of the padding material.

The layers of padding shown in FIGS. 1, 2 and 3 can be constructed usingany suitable hydrophobic/water resistant monofilament yarn such aspolypropylene, polyester, polyethylene and nylon. The monofilament yarnused preferably has a diameter of at least 0.03 mm and is constructedwith a 3D spacer fabric construction to provide sufficient cushioningand breathability, and it has been found that the use of a monofilamenthydrophobic yarn on both faces and in the spacer area provides enhancedwater resistance, light weight, breathability and resistance to collapseand degradation due to moisture and bacteria during extended use. Such afabric is set out in US Published Application No. 2012/0220908, atparagraphs 0063-0068.

The padding material 18A, 18B, 20A, 20B can be constructed using anysuitable organic or inorganic monofilament yarn, preferably ahydrophobic/water resistant monofilament yarn such as polypropylene,polyester, polyethylene and nylon. The monofilament yarn used forconstructing the padding material preferably has a diameter of at least0.03 mm. The padding material is constructed in a 3D spacer fabricconstruction to provide sufficient cushioning and breathability, and ithas been found that the use of a monofilament hydrophobic yarn on bothfaces and in the spacer area provides enhanced water resistance, lightweight, breathability and resistance to collapse and degradation due tomoisture and bacteria during extended use.

The padding material is formed using any suitable fabric formingtechnology such as weaving, various knitting techniques such as, forexample, weft knitting and warp knitting, non-woven, stitching, or acombination of these techniques. Preferably, the structure shouldprovide some stretch in both the length-wise and width-wise directions,and facilitate conforming the undergarment 10 and 30 around ananatomical shape during application.

The padding material can be treated with one or more finishes to provideadditional water resistance, anti-bacterial and/or anti-odorcharacteristics, or aromatherapy to improve the functionality or enhancethe cast-wearing experience for the patient. Alternatively, the paddingmaterial can be fabricated from modified/treated monofilament yarnsincorporating suitable fillers or finishes to improve the performance.

In one preferred embodiment, the undergarment 10 is constructed as a 3Dspacer fabric using polypropylene monofilament and a low tack, pressuresensitive adhesive on one surface. The monofilament yarn has a diameterof at least 0.03 mm, and preferably between 0.05-0.25 mm. Preferably,the padding material requires no additional finish or water repellencytreatment.

More specifically, one preferred embodiment of the padding material isconstructed of a polypropylene monofilament yarn on a double needle bedknitting machine, and can be knitted on either a warp knitting Raschelmachine or a Crochet knitting machine. The padding material ispreferably constructed using a pillar and inlay stitch on the surfacesand a 3 or 5 needle V in the spacer area. The yarn has a diameter of0.03-0.25 mm. The fabric for the padding material is formed with atleast 50 courses per meter preferably 200-850 courses per meter. Thepadding material weighs between 50-400 g/m², and more preferably between100-250 g/m². The padding material has a nominal thickness when notcompressed or under tension of approximately 1.5-3.5 mm.

Alternatively, an undercast liner may be constructed as a spacer fabricwith at least one of the yarns being a multifilament or spun yarn inorder to provide even more patient comfort. The liner may be treatedwith suitable fluorochemical, silicone or other water repellant finishto improve drainage and provide faster drying.

The padding material may also be formed using any suitable fabricforming technology such as weaving, various knitting techniques such as,for example, weft knitting and warp knitting, non-woven, stitching, or acombination of these techniques. Preferably, the structure shouldprovide some stretch in both the length-wise and width-wise directions,and facilitate conforming the undergarment 10 or 30 around theanatomical shape of the body torso and legs during application.

As noted above, Delta-Dry® brand synthetic padding is preferred. Thefabric weight off of the machine and after a 60 minute relaxation periodis 105 g/m². Referring now to FIGS. 4 and 5, and by way of example, theundergarment 30 of FIG. 3 is applied to the infant by donning it overthe legs and up across the torso to the medically-appropriateposition-generally at or just below the armpits. As noted above, thestretch provided by the undergarment 30 permits a fast, accurate,closely-conforming application without wrinkles or creases. Nostockinette or other material is used underneath the undergarment 30. Itresides directly against the skin. The perineal opening 50 is eitherpreformed in the undergarment 30 or formed during application.

As is shown in FIG. 5, after application of the undergarment 30, awrapping of synthetic cast tape 60 is applied. The preferred cast tapeis Delta-Cast® brand synthetic fiber cast tape or Delta-Lite® brandfiberglass cast tape manufactured and sold by BSN medical, Inc. and BSNmedical, GmbH. These cast tapes are supplied in various widths, theparticular width being a choice left to the physician or casttechnician. Two-inch or three-inch cast tape is the most often used. Thecast tape 60 is removed from its moisture impervious pouch, wetted, andexcess water removed by wringing the cast tape 60 while wrapped in anabsorbent towel. The cast tape 60 is then applied over the undergarment30 by wrapping the cast tape 60 circumferentially around the patient andapplied to the injured limb, taking care in the usual manner to properlyoverlap adjacent wraps, eliminate wrinkles and puckers and leaving ashort width of exposed undergarment at the top opening 42, leg openings44 and 46, and perineal opening 50. The result is the cast 62 shown inFIG. 5. The specific manner of application of the cast tape is a matterof medical procedure. One such procedure, illustrated with a prior artapplication of an underwrapping of strips of padding material, iscontained in Application Manual-Hip Spica Cast, published by BSNmedical, Inc., ©BSN medical, Inc., 2011, at pages 10-16.

The cast tape 60 hardens in several minutes to form a rigid cast 60 asshown in FIG. 5 that is nevertheless very water and air permeable.Typically, the torso portion of the cast 60 can be covered in a softcloth or garment, or the patient's arms covered in a soft garment, inorder to prevent chafing of the patient's arms against the outer surfaceof the cast tape 60 on the torso portion of the cast 62.

For infant or small juvenile patients, the patient can be held inproximity to, for example, a handheld spray nozzle and the cast sprayedwith a gentle spray of warm, cleansing water. Urine is readily washedaway, and feces are dissolved, diluted and allowed to drain away. Thepatient is left clean and odor-free, Excess surface water is easilyblotted away with an absorbent cloth or paper towel, and water on theinterior evaporates within about one hour. This process can be repeatedas necessary during the entire treatment period. Moreover, because ofthe ability to cleanse the patient as described above, it may not benecessary to provide the perineal opening in some instances.

An undergarment for use in forming a hip spica cast, and a hip spicacast according to the invention have been described with reference tospecific embodiments and examples. Various details of the invention maybe changed without departing from the scope of the invention.Furthermore, the foregoing description of the preferred embodiments ofthe invention and best mode for practicing the invention are providedfor the purpose of illustration only and not for the purpose oflimitation, the invention being defined by the claims.

We claim:
 1. A water and air permeable undergarment for use with a casttape to form a hip spica cast comprising a layer of a 3D spacersynthetic padding material that is water and air permeable and is formedinto a fabric of monofilament yarns and fabricated into an anatomicallycorrect undergarment structure for being positioned around a torso andadapted to reside directly against the skin of a hip spica cast patient.2. The water and air permeable undergarment according to claim 1,wherein the undergarment includes the torso portion and at least oneintegrally-formed leg portion.
 3. The water and air permeableundergarment according to claim 1, wherein the torso portion of theundergarment includes a top opening for being positioned on a torsoportion of the patient and at least one integrally-formed leg portionterminating in a leg opening adapted to reside between a hip and knee ofthe patient.
 4. The water and air permeable undergarment according toclaim 1, wherein the torso portion of the undergarment includes a topopening for being positioned on a torso portion of the patient andwherein the first and second leg portions terminate in respective legopenings adapted to reside between the hips and knees of the patient. 5.The water and air permeable undergarment according to claim 1, whereinthe undergarment has a torso portion and first and second leg portionsterminating in respective leg openings, and the undergarment is formedof overlaid padding layers defining an anterior side and a posteriorside of the undergarment.
 6. The water and air permeable undergarmentaccording to claim 1, wherein the first and second padding layers andthe third and fourth padding layers are joined along left and right seamlines extending from a top opening to first and second leg openings at alowermost terminus of the undergarment.
 7. The water and air permeableundergarment according to claim 6, wherein the first, second, third, andfourth padding layers include thermoplastic monofilament yarns and theseam lines are formed by a seaming process selected from the groupconsisting of ultrasonic energy, butt seaming, overedge seaming, joiningwith an adhesive tape and joining in with an atomized glue.
 8. The waterand air permeable undergarment according to claim 1, wherein theundergarment includes a perineal opening.
 9. The undergarment accordingto claim 1, wherein the undergarment is configured to form anundergarment for a pantaloon hip spica cast.
 10. The water and airpermeable undergarment according to claim 1, wherein the cast tape isselected from the group consisting of a synthetic fiber orfiberglass/non fiberglass substrate coated or saturated with amoisture-curable resin and stored in a flexible condition in a moistureimpervious package until use, at which time removal of the cast tapefrom the moisture impervious package and exposure to moisture causes thesubstrate to harden over a time period sufficiently long to allowapplication of the cast tape while still flexible over the undergarment.11. The water and air permeable undergarment according to claim 1,wherein the 3D spacer synthetic padding material is formed into aknitted fabric of monofilament yarns and fabricated into an anatomicallyappropriate undergarment structure for being positioned around a torsoand adapted to reside directly against skin of a hip spica cast patient;the fabric for the padding material formed with 200-850 courses permeter; and the padding material weighs between 50-400 g/m² and has anominal thickness when not compressed or under tension of approximately1.5-3.5 mm.
 12. The water and air permeable undergarment according toclaim 11, wherein the undergarment has a torso portion including a topopening for being positioned on a torso portion of the patient and atfirst and second leg portions terminating in respective leg openingsadapted to reside between hips and knees of the patient, and wherein theundergarment is formed of first and second overlaid padding layersdefining an anterior side of the undergarment and third and fourthoverlaid padding layers defining a posterior side of the undergarment.13. The water and air permeable undergarment according to claim 11,wherein the first and second padding layers and the third and fourthpadding layers are joined along left and right seam lines extending froma top opening to first and second leg openings at a lowermost terminusof the undergarment.
 14. The water and air permeable undergarmentaccording to claim 11, wherein the padding material weighs between100-250 g/m².
 15. A hip spica cast, comprising: (a) a water and airpermeable undergarment comprising a water and air permeable 3D spacersynthetic padding material formed into a fabric of monofilament yarnsand fabricated into an anatomically correct undergarment structure forbeing positioned around a torso; and (b) a cast tape adapted to bepositioned circumferentially over the undergarment and around the torsoof the patient.
 16. The hip spica cast according to claim 15, whereinthe undergarment comprises a pantaloon garment having a torso portionand first and second leg portions.
 17. The hip spica cast according toclaim 15, wherein the undergarment has a torso portion including a topopening for being positioned on a torso portion of the patient and atfirst and second leg portions terminating in respective leg openingsadapted to reside between hips and knees of the patient, and wherein theundergarment is formed of first and second overlaid padding layersdefining an anterior side of the undergarment and third and fourthoverlaid padding layers defining a posterior side of the undergarment.18. The hip spica cast according to claim 15, wherein the first andsecond padding layers and the third and fourth padding layers are joinedalong left and right seam lines extending from a top opening to firstand second leg openings at a lowermost terminus of the undergarment. 19.The hip spica cast according to claim 15, wherein the padding materialweighs between 100-250 g/m².
 20. The hip spica cast according to claim15, wherein the monofilament yarns are thermoplastic and the seam linesare formed by a seaming process selected from the group consisting ofultrasonic energy, butt seaming, overedge seaming, joining with anadhesive tape and joining in with an atomized glue.
 21. The hip spicacast according to claim 15, wherein the undergarment includes a perinealopening.